Basic Information
| Provider Information | |||||||||
| NPI: | 1033149281 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CH PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 42510 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972420510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039631294 | ||||||||
| FaxNumber: | 5032301541 | ||||||||
| Practice Location | |||||||||
| Address1: | 914 NW 13TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972093039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712449000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 06/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | HOOBLER | ||||||||
| AuthorizedOfficialFirstName: | COLIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PT | ||||||||
| AuthorizedOfficialTelephone: | 9712446000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 840342000 | 01 | BLUE CROSS | OTHER |